Journal of Gastrointestinal Surgery最新文献

{"title":"Defining a new 6-factor Charlson Comorbidity Index utilizing data points available in the American College of Surgeons National Surgical Quality Improvement Program for patients undergoing pancreatoduodenectomy","authors":"John Christopher Polanco-Santana ,&nbsp;João P.G. Kasakewitch ,&nbsp;Kaique Filardi ,&nbsp;Scott C. Fligor ,&nbsp;Manuel Castillo-Angeles ,&nbsp;Tara S. Kent","doi":"10.1016/j.gassur.2025.102319","DOIUrl":"10.1016/j.gassur.2025.102319","url":null,"abstract":"<div><h3>Background</h3><div>The Charlson Comorbidity Index (CCI) is widely used in surgical research to summarize patients’ baseline comorbidities. However, large surgical databases, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), lack key CCI components, limiting its applicability. Developing a modified CCI (mCCI) using available ACS-NSQIP variables could improve baseline risk stratification for patients undergoing pancreatoduodenectomy (PD). This study aimed to define such an mCCI and evaluate its performance compared with that of the conventional CCI.</div></div><div><h3>Methods</h3><div>This was a 2-phase retrospective study that included patients who underwent PD. In the derivation phase, our institutional ACS-NSQIP database (2015–2021) was used to construct the mCCI, with scores reweighted to the observed 14-point maximum. The Spearman rank correlation was used to evaluate the relationship between CCI and mCCI. The nationwide ACS-NSQIP database (2022) was used for external validation. Unadjusted logistic regression models were constructed to predict discharge disposition and postoperative complications. Model discrimination was evaluated using area under the receiver operating characteristic curve (AUC)/receiver operating characteristic curve analysis with AUCs compared with the DeLong test.</div></div><div><h3>Results</h3><div>A total of 333 institutional and 4867 national patients who underwent PD were included. In the derivation cohort, the mCCI was strongly correlated with the CCI (<em>r</em> = 0.85; <em>P</em> &lt;.001). For discharge disposition, both indices yielded an AUC of 0.74. For postoperative complications, AUCs were 0.50 for CCI and 0.55 for mCCI. Similar trends were observed in external validation. No significant differences were found in the discriminatory capacities between the models.</div></div><div><h3>Conclusion</h3><div>mCCI is a reasonable alternative to account for baseline comorbidities in patients undergoing PD using the ACS-NSQIP database. Further studies should refine weighting schemes across diverse populations to optimize mCCI performance.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102319"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rendezvous robotic endoscopic retrograde cholangiopancreatography for complex Mirizzi","authors":"Akanksha Talwar ,&nbsp;Zhi Ven Fong ,&nbsp;Irving A. Jorge","doi":"10.1016/j.gassur.2026.102369","DOIUrl":"10.1016/j.gassur.2026.102369","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102369"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal metastasis to the pancreas: a comprehensive review","authors":"Hassan Aziz ,&nbsp;Aditya Kotla ,&nbsp;Raegen Abbey ,&nbsp;Brandon C. Toliver ,&nbsp;Matthew Gosse ,&nbsp;Nikahat Yasmine ,&nbsp;Yashant Aswani ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2026.102347","DOIUrl":"10.1016/j.gassur.2026.102347","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic metastases are rare, accounting for 2% to 5% of all pancreatic malignancies. Renal cell carcinoma (RCC) is the most common primary cancer that metastasizes to the pancreas and accounts for 30% to 40% of all pancreatic metastatic lesions. Most reported cases involve clear cell RCC (ccRCC), although data regarding pancreatic metastases from non–ccRCC subtypes remain limited. Unlike metastases from other primary tumors, pancreatic metastases from RCC (PM-RCC) often follow a more indolent clinical course and are associated with a relatively favorable prognosis, suggesting distinct underlying biological behavior.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted using the MEDLINE/PubMed, Google Scholar, Cochrane Library, and Web of Science databases (January 1993 to May 2025). Eligible studies included full-text articles, case reports, and original research describing RCC metastasis to the pancreas, with an emphasis on the mechanism, diagnosis, treatment, and outcomes.</div></div><div><h3>Results</h3><div>The disproportionate tendency of kidney cancer to metastasize to the pancreas is best explained by the “seed and soil” hypothesis, reflecting a selective affinity between RCC cells and the pancreatic microenvironment. PM-RCC are usually metachronous, often occurring many years after nephrectomy, and are frequently asymptomatic and discovered incidentally on surveillance imaging. Characteristic imaging findings include hypervascular lesions on contrast-enhanced computed tomography or magnetic resonance imaging. Histopathologic confirmation is crucial, as PM-RCC have a markedly better prognosis than primary pancreatic neoplasms. Surgical resection remains the mainstay of treatment of isolated disease, with a 5-year survival rate exceeding 50%. In the era of targeted immunotherapy, systemic treatments further improve outcomes, with the median overall survival surpassing that of patients with extrapancreatic metastases.</div></div><div><h3>Conclusion</h3><div>PM-RCC are a unique clinical and biological entity characterized by indolent progression, favorable survival, and a strong response to surgical and targeted therapies. Understanding the molecular and microenvironmental mechanisms underlying this selective organotropism may refine therapeutic strategies and provide insights into the broader principles of metastatic disease.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102347"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of outcomes and costs of lung and esophageal resection: epidural analgesia vs peripheral nerve block","authors":"Qaidar Alizai,&nbsp;Azza Sarfraz,&nbsp;Odysseas P. Chatzipanagiotou,&nbsp;Areesh Mevawalla,&nbsp;Meher Angez,&nbsp;Abdulaziz Elemosho,&nbsp;Peter Kneurtz,&nbsp;Desmond D’Souza,&nbsp;Robert Merritt,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2026.102354","DOIUrl":"10.1016/j.gassur.2026.102354","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic epidural analgesia (EA) has historically been a key component of multimodal analgesia after open thoracotomy. EA use has decreased over time, however, and peripheral nerve blocks (PNBs) are increasingly used as alternatives. This study aimed to compare outcomes among patients receiving EA versus PNB as part of a lung or esophageal operative procedure.</div></div><div><h3>Methods</h3><div>Adult patients who received EA or PNB as part of a lung or esophageal operative procedure from 2016 to 2020 were identified in the Nationwide Readmissions Database. Outcomes included complications, 90-day readmission, mortality, length of stay (LOS), and hospitalization costs. Patients were stratified according to analgesia type and 1:2 propensity score matching (PSM) adjusted for patient, surgical, and hospital characteristics. Multivariate regression was used to address residual confounding.</div></div><div><h3>Results</h3><div>Among 8668 patients, 738 (8.5%) received EA, and 7930 (91.5%) received PNB. After PSM (N = 2110; 721 in the EA group vs 1389 in the PNB group), EA remained associated with longer LOS (β = 1.12 days [95% CI, 0.85–1.39]) and higher index admission (β = $3630 [95% CI, $2061–5199]) and total 90-day costs (β = $4808 [95% CI, $3230-$6386]) (all <em>P</em> &lt;.001). In site-stratified multivariate models, EA was associated with higher median 90-day costs after esophageal resection ($12,487) and lung resection ($2970) and longer LOS (esophagus: β = 1.93; lung: β = 1.00 days). In addition, EA was associated with higher odds of ileus after esophageal resection (adjusted odds ratio, 18.47). Other complications, readmission, and 90-day mortality did not differ (all <em>P</em> &gt;.05).</div></div><div><h3>Conclusion</h3><div>EA was associated with a longer hospital stay and higher median costs than PNB, with no differences in clinical outcomes. These findings support the use of PNB as an equally safe and more cost-conscious analgesic strategy in thoracic surgery.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102354"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause of dysphagia: a giant pedunculated esophageal lipoma","authors":"Rui Zhong,&nbsp;Kui Zhao","doi":"10.1016/j.gassur.2026.102356","DOIUrl":"10.1016/j.gassur.2026.102356","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102356"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to Editor regarding: \"Overuse of subtotal cholecystectomy: surgeon practice patterns and outcomes in a large healthcare system\".","authors":"Farman Ali","doi":"10.1016/j.gassur.2026.102384","DOIUrl":"https://doi.org/10.1016/j.gassur.2026.102384","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"102384"},"PeriodicalIF":2.4,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited commentary on “Restoring bowel continuity after extended left colectomy: a comparative study of the retroileal window and Deloyers techniques”","authors":"Vitaliy Poylin","doi":"10.1016/j.gassur.2025.102309","DOIUrl":"10.1016/j.gassur.2025.102309","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 3","pages":"Article 102309"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in presentation and outcomes after surgery for medically refractory gastroparesis: the impact of demographic and socioeconomic status","authors":"Emma Venard ,&nbsp;Sven E. Eriksson ,&nbsp;Margaret Gardner ,&nbsp;Ping Zheng ,&nbsp;Shahin Ayazi","doi":"10.1016/j.gassur.2025.102312","DOIUrl":"10.1016/j.gassur.2025.102312","url":null,"abstract":"<div><h3>Background</h3><div>Gastroparesis is a debilitating disorder, and surgical therapy can provide meaningful improvement in patients who remain symptomatic despite medical treatment. However, patients often present with variable disease severity, and the influence of demographic and socioeconomic factors on this variability and on postoperative outcomes remains poorly defined. This study aimed to evaluate the effect of demographic status and socioeconomic status (SES) on preoperative characteristics and postoperative outcomes in patients who underwent surgery for medically refractory gastroparesis.</div></div><div><h3>Methods</h3><div>All patients who underwent surgical treatment of medically refractory gastroparesis between 2012 and 2024 at a tertiary foregut center were retrospectively analyzed. Demographics, gastroparesis etiology, gastric emptying, and Gastroparesis Cardinal Symptom Index (GCSI) scores were compared across sex, race, age, and SES groups. SES classification was derived from zip code–level United States census data. Surgical procedures included pyloroplasty, gastric peroral endoscopic pyloromyotomy, and gastric electrical stimulation.</div></div><div><h3>Results</h3><div>A total of 387 patients were included (82.4% female; mean age of 51.3 ± 15.6 years). Idiopathic (62.3%) and diabetic (23.9%) etiologies predominated. Overall, GCSI total score improved significantly (median: 3.1 [IQR, 2.5–3.9] to 2.4 [IQR 1.6–3.3]; <em>P</em> &lt;.001), and gastric retention at 4 h decreased (29.0% [IQR, 17.0%–44.9%] to 8.0% [IQR, 1.0%–24.0%]; <em>P</em> &lt;.001). African American patients presented with higher baseline GCSI total score (median: 4.3 [IQR, 3.3–4.8] vs 3.1 [IQR, 2.4–3.8]; <em>P</em> =.011) and continued to report higher postoperative symptom scores (GCSI total score: 3.1 vs 2.4; <em>P</em> =.031). Similarly, patients with low SES demonstarted a trend toward more severe preoperative symptoms and higher gastric retention but achieved postoperative improvement comparable with those with higher SES. A significant correlation between preoperative gastric emptying at 4-hour retention and GCSI total score was observed only in men, both preoperatively (<em>r</em> = 0.46; <em>P</em> =.049) and postoperatively (<em>r</em> = 0.60; <em>P</em> =.025). Younger patients were less likely to have symptom resolution (<em>P</em> =.035).</div></div><div><h3>Conclusion</h3><div>Surgical treatment achieved durable improvement in medically refractory gastroparesis, with similar postoperative gains across SES groups. Persistent symptoms in African American and younger patients and sex-specific differences in symptom-motility correlation suggest multifactorial mechanisms beyond motility alone.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 3","pages":"Article 102312"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of exercise modalities on psychological outcomes and quality of life in digestive system cancer survivors: a systematic review and network meta-analysis","authors":"Jiaqi Li,&nbsp;Qian Zhang,&nbsp;Wei Ning,&nbsp;Zhenzi Wang","doi":"10.1016/j.gassur.2025.102313","DOIUrl":"10.1016/j.gassur.2025.102313","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of digestive system cancers frequently experience depression, anxiety, fatigue, and impaired health-related quality of life (HRQoL). Exercise has emerged as a promising adjunctive therapy. However, the optimal modality and prescription remain unclear. This study aimed to evaluate the effects of exercise on psychological outcomes and HRQoL, to rank the relative efficacy of different modalities, and to identify optimal exercise characteristics through subgroup analyses.</div></div><div><h3>Methods</h3><div>PubMed, Embase, CENTRAL, Web of Science, and Google Scholar were searched until August 31, 2025, for randomized controlled trials (RCTs) of exercise interventions in adult survivors of digestive system cancers. Eligible comparators included usual care, no intervention, or alternative exercise. The primary outcomes were HRQoL, fatigue, depression, and anxiety, which were measured using validated instruments. The standardized mean differences (SMDs) with 95% CIs were used as effect estimates. Pairwise meta-analyses were performed with random-effects models, and Bayesian network meta-analysis was used to compare exercise modalities. Subgroup analyses were used to examine moderators, including cancer type, exercise intensity, frequency, session duration, and intervention length.</div></div><div><h3>Results</h3><div>A total of 38 RCTs that involved 3255 participants were included. The exercise group significantly had improved HRQoL (SMD, 0.43 [95% CI, 0.27–0.59]) and reduced fatigue (SMD, −0.52 [95% CI, −0.72 to −0.32]), depression (SMD, −0.37 [95% CI, −0.58 to −0.15]), and anxiety (SMD, −0.33 [95% CI, −0.44 to −0.21]) compared with the control group. Network meta-analysis indicated that mind-body exercise (such as yoga or tai chi) was most effective for HRQoL (SMD, 0.68 [95% CI, 0.22–1.14]) and depression (SMD, −0.55 [95% CI, −0.95 to −0.16]), resistance training for fatigue (SMD, −0.79 [95% CI, −1.35 to −0.23]), and combined training (CT) for anxiety (SMD, −0.38 [95% CI, −0.53 to −0.23]). Subgroup analyses showed that moderate-intensity, moderate-frequency, and medium-to-long interventions produced the most consistent benefits.</div></div><div><h3>Conclusion</h3><div>Exercise interventions significantly improved HRQoL and reduced depression, anxiety, and fatigue in survivors of digestive system cancers. Mind-body exercise (eg, yoga or tai chi) demonstrated the greatest benefits for HRQoL and depression, resistance training best alleviated fatigue, and CT reduced anxiety. Moderate-intensity, sustained programs achieved the most consistent benefits, supporting individualized exercise prescriptions in survivorship care.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 3","pages":"Article 102313"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Light amplification by stimulated emission of radiation in fistula-in-ano: innovation or impetuosity? Current position","authors":"Vipul D. Yagnik ,&nbsp;Prema Ram Choudhary ,&nbsp;Pankaj Garg","doi":"10.1016/j.gassur.2026.102328","DOIUrl":"10.1016/j.gassur.2026.102328","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 3","pages":"Article 102328"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}